Healthcare Funding Gaps Deepen Humanitarian Crisis in Puerto Rico

By David Thomsen, Policy Analyst, Health Policy Project, NCLR

Members of Congress held a press conference last week to highlight the need for Congress to act.

Members of Congress held a press conference last week to highlight the need for Congress to act.

The decade-long economic recession engulfing Puerto Rico and its 3.5 million American citizens has become a humanitarian crisis. Governor Alejandro Garcia Padilla’s recent announcement that the island’s $73 billion debt was “not payable” is a call to action for leaders in Puerto Rico and Washington, D.C. to address this issue in a meaningful way. This crisis not only impacts the Puerto Rican economy—it severely impacts the ability of American citizens to access vital health services. Puerto Rico’s Medicaid, Medicare, and Medicare Advantage programs, which provide health coverage for 2.37 million people, face a catastrophic funding shortfall of up to $3 billion over the next two years. This shortfall could leave thousands of Puerto Ricans without health coverage by 2017.

The island can ill afford any more bad news. Nearly half of the population lives in poverty (45 percent), and as a result, 1.6 million Puerto Ricans count on the island’s Medicaid program Mi Salud for health care coverage. Although residents contribute the same amount in health care taxes as mainland residents, the federal government has long treated Puerto Rico’s health care system differently. While the federal government effectively covers between 50 percent and 83 percent of annual state Medicaid costs, it only funds between 15 percent and 20 percent of Mi Salud, leaving Puerto Rico to fund the balance of its $2.5 billion program. As a result, health care costs alone account for $25 billion of the island’s debt total.

In 2010, prior to passage of the Affordable Care Act (ACA), the federal government’s contribution to Mi Salud was $364 million. Comparatively, Oklahoma, with a population of 3.9 million, receives $3.5 billion for its Medicaid program. The ACA temporarily addressed this monumental funding gap by providing a one-time boost of $5.5 billion for Mi Salud. However, due to the continuing financial crisis and structural funding disparities, this funding stream could be depleted as early as the end of 2016, once again leaving the island with a large Medicaid funding gap.

HEALTH CR School 3This is especially problematic as the island struggles to pay its debt and fund basic public services. Without Congressional action, the island’s federal contribution will fall back to its pre-ACA average of around $400 million, devastating a health care system already under tremendous strain. An estimated 900,000 Puerto Ricans could lose their health care coverage when this temporary funding runs out.

Puerto Rico’s seniors unfortunately are not immune to funding cuts either. In January, the federal government will cut funding for Puerto Rico’s Medicare Advantage program by 11 percent. Medicare Advantage, an alternative to the traditional Medicare program in that it’s offered by private companies, forms the backbone of the island’s Medicare program. These cuts will hit nearly 560,000 Puerto Rican seniors enrolled in Medicare Advantage, resulting in higher co-pays for medication and hospitalization for many poor and chronically ill patients. These cuts are due even as the states are slated for a three percent increase in federal funding.


Like Medicaid, Medicare Advantage funding cuts could not come at a worse time. According to the Puerto Rico Healthcare Crisis Coalition, Medicare reimbursement rates are already 40 percent lower than the mainland U.S. and the Medicare Advantage reimbursement rate is just 60 percent of the mainland’s. These disparities exist despite the fact that Puerto Ricans contribute as much in Medicare payroll taxes as their fellow mainland U.S. residents. Medicare beneficiaries in Puerto Rico already report worse healthcare experiences than mainland beneficiaries for several outcomes including access to needed care, getting timely care, and immunization rates. These cuts will only exacerbate these disparities.

Vast disparities in Medicaid and Medicare reimbursement rates have already contributed to around 3,000 doctors leaving Puerto Rico in the past five years alone, resulting in a tremendous shortage of internists and specialists. To make matters worse, a growing number of medical graduates, along with thousands of other Puerto Ricans, are leaving to pursue jobs on the mainland due to the lack of economic opportunities on the island.

As Puerto Rico’s financial crisis deepens, so will its impact on the most vulnerable populations, including the poor, seniors, and the chronically ill. Our fellow Americans in Puerto Rico deserve the right to access healthcare. It is time for Congress to take action and address health care funding gaps—ensuring that our fellow Americans on the island of Puerto Rico have access to vital public health services.

This Week in Immigration Reform — Week Ending July31

Immigration_reform_Updates_blueWeek Ending July 31

This week in immigration: NCLR responds to Donald Trump’s mass deportation proposal; check out the facts about immigrants and Medicare; and read a blog post featuring citizenship lending circles.

  • NCLR Deputy Vice President, Clarissa Martinez de Castro was interviewed by Univision for their nightly news segment on Donald Trump’s proposal that the 11 million undocumented immigrants in this country should be deported:  You can see her response here.
  • This week Medicare — which provides healthcare coverage to America’s seniors — turned 50.  It’s a good opportunity to highlight that immigrants have been contributing to Medicare and helping to sustain the program.  Check out our infographic for more info:
  • This week on the NCLR blog, we featured the work NCLR Affiliate, Mission Asset Fund (MAF).  MAF recently received an NCLR Family Strengthening Award at this year’s NCLR Annual Conference in Kansas City.

MAF has formalized the process of Lending Circles, in which a small number of people agree to lend money to each other at no interest, by having registered participants’ payments reported to the national credit bureaus. This helps people who may not otherwise have had access to get into the mainstream financial system, says Ximena Arias, Financial Services Manager at MAF.

Lending Circles can help those who have specific goals in mind, such as paying the application fee to become a citizen. Watch the video to hear Karla Henriquez who has experienced the process both as a participant and as the Programs Coordinator for MAF.

The Economic Impact of Latino Workers: A By-the-Numbers Breakdown for Tax Day

Hispanic Americans are firm believers in the American Dream: hard work will earn you and your family a better life. Expected to make up much of the growth in the American workforce in the next four decades, Latinos are helping to revitalize communities and strengthen local economies all throughout the nation. Hard work however, is just one contributing factor to ensuring that the country remains prosperous. In order to support investments in education, infrastructure, health care, and many other areas that millions of Americans rely on, everybody must contribute financially through the tax system. Luckily for this country, Latinos are a tremendous asset thanks to their commitment to paying their fair share of taxes.

In honor of Tax Day, let’s take a by-the-numbers look at the economic impact that Latinos have on the U.S. economy.

Labor Force Participation


Entrepreneurship and Purchasing Power


  • Despite slower growth during the recession, the number of Hispanic-owned business was projected to grow by nearly 40% between 2007 and 2013, to nearly 3.2 million businesses.
  • In 2013, sales receipts for Hispanic-owned businesses in the United States totaled almost $470 billion.
  • Because the Latino population is comparatively younger than other racial and ethnic groups and the number of Hispanics in the United States is quickly growing, Hispanic purchasing power is also expected to grow to nearly $1.7 trillion by 2019.

Tax Contributions

Photo:, Creative Commons

Photo:, Creative Commons

  • In 2013, Hispanic households paid almost $124 billion in federal taxes, including individual and corporate income taxes, payroll taxes, and excise taxes, and almost $67 billion in state and local taxes.
  • States with large Hispanic populations have also benefited from their tax contributions. Hispanic households accounted for 23 percent of state and local tax payments in Texas, 20 percent in California, 18 percent in Florida, and 15 percent in Arizona.
  • Tax contributions from Hispanic households also play a critical role in funding Social Security and Medicare. In 2013, Hispanic households contributed about $98 billion to Social Security and $23 billion to Medicare through payroll taxes. Many economists believe that tax contributions from young Latino workers will be the key to keeping the Social Security system strong.

Weekly Washington Outlook — April 6, 2015


What to Watch This Week:



The House is in recess, returning the week of April 13.


The Senate is in recess, returning the week of April 13.

White House:

On Monday, the president and the his family will participate in the White House Easter Egg Roll. The event will feature live music, sports courts, cooking stations, storytelling, and Easter egg rolling.

On Tuesday, President Obama will host an Easter Prayer Breakfast at the White House; the vice president will also attend.

On Wednesday, the president will depart the White House en route to Kingston, Jamaica.

On Thursday, President Obama will hold a bilateral meeting with Prime Minister Portia Simpson-Miller of Jamaica and participate in a meeting with Caribbean Community leaders. The president will also participate in a town hall with young leaders. In the evening, President Obama will depart Kingston en route to Panama City, Panama.

On Friday, the president will hold a bilateral meeting with Panamanian President Juan Carlos Varela and participate in the Summit of the Americas CEO Forum. In the evening President Obama will attend the Summit of the Americas Opening Ceremonies.

On Saturday, the president will attend official Summit of the Americas events. The President will participate in a press conference before departing Panama en route to Washington.

Coming Up Next Week:

Budget – When Congress returns on the April 13, the budget process will continue, with House Budget Committee Chairman Price (R-Ga.) and Senate Budget Chairman Enzi (R-Wyo.) wanting to resolve differences in the budget by April 15, the statutory deadline for adopting a concurrent resolution. There is no penalty for failing to meet the deadline, whether by adopting a budget late or not adopting one at all. If no agreement is reached, each chamber can deem its resolution as binding on the spending and revenue bills that come later.

Nominations – When the Senate returns, the chamber may resume consideration of a stalled anti-trafficking bill that has become mired in abortion politics. Majority Leader Mitch McConnell has said repeatedly that the Senate must complete work on this legislation before he will move to confirm Loretta Lynch to be Attorney General. Last week Senator Kirk (R-Ill.) became the fifth Republican to say he will vote to confirm Lynch, hypothetically assuring her confirmation.

Health – The Senate is expected to vote in mid-April on legislation that would permanently alter Medicare’s sustainable growth rate. This legislation also extends the Children’s Health Insurance Program (CHIP) for two years. It passed overwhelmingly in the House on March 26.

Education – There is considerable speculation House Leadership will try again to pass H.R. 5, an ESEA reauthorization bill, after the recess. The legislation had to be pulled from the floor in February and it is still unclear whether the measure has enough Republican support. In the Senate, Health, Education, Labor, and Pensions (HELP) Committee Chairman Alexander (R-Tenn.) and Ranking Member Murray (D-Wash.) are continuing to negotiate a bipartisan ESEA reauthorization bill.  A mark-up has been scheduled for the week of April 13, and it is possible details may soon be announced.

Weekly Washington Outlook – March 31, 2014

U.S. Capitol

What to Watch This Week:


The House:

The House convenes on Tuesday and will take up seven bills under suspension of the rules, including two Senate-passed bills that would provide aid to Ukraine and sanction Russia for its invasion of Crimea.  The remaining five measures would:

Later in the week, the House will consider the Save American Workers Act of 2014 (H.R. 2575) and the Pro-Growth Budgeting Act of 2013 (H.R. 1874).  The first would change the Affordable Care Act’s definition of a full-time employee under the law’s employer mandate from thirty hours a week to forty hours a week.  The second would require the Congressional Budget Office to produce a macroeconomic analysis for legislation passed out of committees.

The Senate:

The Senate comes back into session on Monday afternoon and will consider the House-passed Protecting Access to Medicare Act of 2014 (H.R. 4302).  The so-called “doc fix” would extend the Medicare reimbursement rate for physicians for twelve months and add a 0.5 percent increase.  Following passage, the Senate is expected to take a procedural vote on a five-month unemployment insurance extension.  A vote on passage is expected before the end of the week.  Several judicial nominations are also scheduled for confirmation this week.

White House:

On Monday, the president will attend unspecified meetings at the White House.  On Tuesday, President Obama will welcome the Boston Red Sox to the White House to honor the team and their 2013 World Series Championship.  On Wednesday, the he will travel to Ann Arbor, Michigan for an event on his proposal to raise the national minimum wage.  Following this event, the president will travel to Chicago to attend Democratic National Committee events. On Thursday, the president and First Lady will host members of the United States teams and delegations from the 2014 Olympic and Paralympic Winter Games at the White House.  On Friday, President Obama will host Prime Minister Mehdi Jomaa of Tunisia at the White House.  During the meeting, the two leaders will discuss Tunisia’s democratic transition and a broad range of bilateral and regional issues of mutual interest, including U.S. economic, political, and security assistance to support the Prime Minister’s reform agenda and Tunisia’s stability.  Continue reading